Willing Hearts Dalmatian Rescue, Inc Adoption Application

Thank you for applying with Willing Hearts Dalmatian Rescue (WHDR)

Our adoption fee is $400.00

Contact Information

Name of Adopter(s)

Today's Date

MonthDayYearHourMinutesAM/PM Option

Ages

Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code

E-mail

Can WHDR contact you by e-mail for WHDR related information?

YesNo

Phone Number

Cell Phone

Employer Information

Primary Adopter Employer

Primary Employer City

Primary Employer Phone

Secondary Adopter Employer

Secondary Adopter City

Secondary Adopter Employer Phone

Forever Pet Information

Best Time to be Contacted?

Which dog are you interested in?

If no specific dog, what age/sex/breed?

Do you prefer a non-shedder?

YesNo

Why do you want to adopt a dog?

Do you consider yourself / family to be active in such a way that would include a dog?

YesNo

Please Explain:

What dogs/cats do you currently have?

Breed

Dog/Cat Status*

LivingDeceasedN/A

Deceased: Please Explain

Dog's Name & Age

Cat's Name & Age

DOG'S SEX

DOG SPAYED/NEUTERED

Indoor/Outdoor

CAT'S SEX

CAT SPAYED/NEUTERED

Indoor/Outdoor

Breed

Dog/Cat Status*

LivingDeceasedN/A

Deceased: Please Explain

Dog's Name & Age

DOG'S SEX

DOG SPAYED/NEUTERED

Is Dog Indoor/Outdoor

Breed

Dog's Name & Age

Dog/Cat Status*

LivingDeceasedN/A

Deceased: Please Explain

DOG'S SEX

DOG SPAYED/NEUTERED

Is Dog Indoor/Outdoor

Breed

Dog/Cat Status*

LivingDeceasedN/A

Deceased: Please Explain

Dog's Name & Age

DOG'S SEX

DOG SPAYED/NEUTERED

Is Dog Indoor/Outdoor

How do your dogs/cats get along with other dogs/cats?

If you don’t have a dog or cat now, what dogs/cats have you had in your adult life?

Breed

SEX

SPAYED/NEUTERED

Indoor/Outdoor

What happened to your animal?

Breed

SEX

SPAYED/NEUTERED

Indoor/Outdoor

What happened to your animal?

Ever train in obedience?

YesNo

What discipline method do you use, how do you correct you dog(s)?

Willing to train in obedience?

YesNo

What dog food do you use?

How often?

Wet / Dry

Wet FoodDry Food

Do you use Heartworm Preventative?

YesNo

What kind?

Have you ever bred a litter?

YesNo

Have you ever adopted/rescued a dog/cat before?

YesNo

From who? (Name & Number)

Have you ever returned a dog to a shelter?

YesNo

If Yes, please explain:

Many Veterinarian's require that we have permission to speak with them. Please call and let them know that a representative of Willing Hearts Dalmatian Rescue will be contacting them. Thank you.

Name of Veterinarian*

Address of Veterinarian

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Veterinarian Phone Number*

Please provide 2 personal reference.

Name Personal Reference #1*

Name Personal Reference #1:

City of Personal Reference #1

Street Address Line 2

City

Personal Reference #1 Phone Number*

Name Personal Reference #2*

Name Personal Reference #2

City of Personal Reference #2

Street Address

Street Address Line 2

City

Personal Reference #2 Phone Number*

Please provide the following information about your yard, crating and home alone accommodations

Size of Yard

Is it completely Fenced?

YesNo

Fence Height?

Type of Fence?

If you do not have a fence, how will the dog be contained?

Do you have a dog kennel?

YesNo

What Type?

What kind of accommodations do you have for the dog in the hot/cold weather?

Is anyone home during the day?

YesNo

How many hours will the dog be left alone?

Where will the dog stay during the day when alone?

Do you own or have a crate?

Type of Crate

What are the ages of children in contact with the dog?

Please describe any neighbors that the dog would be involved with (do they like dogs?, have children (ages), have dogs, cats?

Is there asthma or allergies in the household to dogs or cats?

YesNo

If yes, how severe?

Your Home Information

Own/Rent

Type of Home

How long at address?

Are there any pet restrictions?

Are you willing to have a WHDR member visit your home before and after adoption?

Name and number of Park Manager (if applicable)

If you rent, a letter of permission from your landlord will be required prior to adoption.

Name of Landlord

Address of Landlord

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Landlord's Phone

Do all parties in the household want a dog?

Adopted pets need adjustment time, are you willing to give the new dog at least one month trial period to ensure proper adjustment?

What would, in your opinion, constitute a reason for not keeping the dog?

We are always in need of temporary homes for our rescue dogs.

Would you be willing to foster a needy dog/puppy if it is compatible with your lifestyle and other pets?

For how long?

Until placed?

YesNo

Please enter any comments or questions here:

Terms Agreement & Signature

I/We understand that if we cannot keep the dog it will never be sold, given away, traded, abandoned, or otherwise disposed of to any person(s), dealer, retailer, auction institute or other entity for ANY reason. I/We understand the dog MUST be returned toWilling Hearts Dalmatian Rescue (WHDR), no exceptions. I/We agree that we will notify a member of WHDR in a timely manner to make arrangements for the return of the dog. I/We agree I/we will humanely house and care for the dog until arrangements can be made with WHDR. If I/We do not return the dog to WHDR we agree to pay $500 to WHDR for violation of this contract.

Signature Line - Please type adopter(s) names as a signature that all information provided is true and accurate and you agree to the terms stated.

Terms Agreement*

I Agree

Primary Adopter

Secondary Adopter

Once you hit Submit your application will be sent through e-mail to WHDR, please allow adequate time for our volunteers to review your application. Thank You!

Pet Adoption Application